Applicants seeking a license to become a third-party administrator (TPA) to represent self-insured employers and/or insurance carriers must qualify under either §50(3-b) or §50(3-d) of the Workers' Compensation Law (WCL). Section 50(3-b) permits those businesses created under the laws of New York State to apply for a license. Businesses established outside of New York may apply for a license under §50(3-d) of the WCL provided they are: (1) an insurance company duly authorized to write workers' compensation insurance in New York; (2) an affiliate or subsidiary of (1); or (3) a licensed/authorized adjusting company in New York. The corporation must submit a certificate from the New York State Insurance Department indicating one of the three criteria listed above if they choose to file under §50(3-d) of the WCL. If the corporation files under §50(3-d) of the WCL, the corporation is required to have a physical place of business and telephone number in the State of New York and must also submit documentation from NYS Department of State, indicating that they are authorized to do business in New York State.
§ 50 3-b/d of the New York State Workers' Compensation Law
A company or corporation applying for a TPA license must have a Qualifying Officer to represent the company or corporation. This individual is responsible for overseeing the company's conduct at Board hearings and ensuring that the laws and regulations of the Board are being followed. An individual can become a Qualifying Officer in one of two ways.
Specifically:
- A company can use an attorney admitted to practice in New York as its Qualifying Officer. A Certificate of Good Standing from the Appellate Division must be submitted with the Qualifying Officer's application. This process is the most expedient way to obtain a license since there is no examination required when the qualifying officer is an attorney, or
- An individual who is not an attorney may apply and take the annually administered licensed representative examination. Upon successful completion of the examination and orientation process, along with Board authorization, the candidate can be appointed as the company's Qualifying Officer.
Application Form and Instructions on How to Become a Licensed Representative
It is important to note, however, that the Qualifying Officer must be designated as an "officer" of the company (i.e., President, Vice President, Secretary, or Treasurer) that is applying to represent self-insured employers and/or carriers. A resolution appointing the Qualifying Officer as an officer of the company must be submitted with the paperwork. The specific arrangements that are made between the company and the Qualifying Officer, with respect to official duties and compensation, if any, does not need to be disclosed to the Board.
Listed below are the forms that are required to be completed:
- Form OC-403.1
(three copies) needs to be completed by two senior officers and the Qualifying Officer. Please note that the Qualifying Officer's signature is required at the top of page three of each OC-403.1, twice on his own form and the acknowledgement at the bottom of page three must be completed. - Form OC-403.2 (one copy) needs to be completed by the Qualifying Officer and any authorized employees, if applicable. An authorized employee is an individual authorized to appear before the Workers' Compensation Board on behalf of the TPA. This individual is not an attorney, but has taken and passed the licensed representative examination.
- Form OC-403.3 (one copy) needs to be completed by each principal stockholder owning at least 20% of the corporation's stock. If the stockholder is an individual, please make sure the verification at the top of page two is completed and notarized. If the stockholder is a corporation, please make sure the verification at the bottom of page two, is completed and notarized.
A check or money order for $100 made payable to the "Chair, Workers' Compensation Board", should be submitted with the application. Once the application has been approved, additional money will be requested to cover the license period.
In addition to completing and submitting the above-mentioned forms, the Qualifying Officer will be required to appear before a Board Panel for an interview. Once the interview is complete, the Full Board will review the recommendation made by the Board Panel and determine if the license should be granted.
The completed forms, along with the check, should be submitted to the Workers' Compensation Board, Licensing Office, 328 State Street, Schenectady, NY 12305-2318. Please contact the Licensing Office at 1-800-664-2379 if you have any questions.
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